Interdigital Neuralgia

(Morton’s neuroma; Morton’s neuroma)

Both an interdigital nerve irritation (neuralgia) and a persistent benign tissue augmentation of the perineurium (neuroma) can cause pain that present themselves nonspecific, burning or lancinating or even cause a foreign body sensation. The diagnosis is made clinically in general. Treatment measures are correction of the footwear, local injections or sometimes surgical excision.

Both an interdigital nerve irritation (neuralgia) and a persistent benign tissue augmentation of the perineurium (neuroma) can cause pain that present themselves nonspecific, burning or lancinating or even cause a foreign body sensation. The diagnosis is made clinically in general. Treatment measures are correction of the footwear, local injections or sometimes surgical excision.

(See also overview of diseases of the feet and ankles.) Both an interdigital nerve irritation (neuralgia) and a persistent benign tissue augmentation of the perineurium (neuroma) can cause pain that present themselves nonspecific, burning or lancinating or even cause a foreign body sensation. The diagnosis is made clinically in general. Treatment measures are correction of the footwear, local injections or sometimes surgical excision. The interdigital neuralgia is a common cause of metatarsalgia. The interdigital nerves of the feet run between the metatarsals and continues distally to innervate the toes. Neuralgia of the interdigital nerve in the area of ??the ball of the foot is usually caused by inadequate or too tight shoes, or more rarely by a deterioration of the nerve due to a deformity of the foot (z. B. Spreizfußdeformität). As a result of the repeated trauma results in a benign thickening of the nerve (Morton’s neuroma). Symptoms and complaints The interdigital neuralgia is characterized by pain in the metatarsal heads or toes. In the early stage, these (usually unilateral) neuralgia often causes mild, occasional pain and discomfort in the foot pads, often only when wearing certain shoes that are too tight forwards. In most cases the neuralgia occurs unilaterally. Later in the thickening of the nerve forms. The pain increases and gets a burning or lancinating character with paresthesias. Over time, the patient can no longer bear the most closed shoes, they have to walk the feeling that a stone is in the shoe, they are trying to remove. The neuroma is most common in the third. Interdigital space located, little rare between the II. And III. Toe. Sometimes both gaps are simultaneously or affected both feet. Diagnosis Clinical examination Symptoms of interdigital neuralgia often have a specific character, and the diagnosis can then plantar palpation with pressure pain in the affected interdigital space and reproduction of austrahlenden burning pain, often accompanied by a noticeable clicking sound to be confirmed by pressing (Mulder’s sign) , Although a neuroma usually can not be confirmed by MRI, but other interdigital problems or arthritis can thus be excluded with similar symptoms. Therapy changes in footwear and injections neuralgia short history can be brought already by using well-fitting shoes or inserts, or by injection of local anesthetics often subside. Using a metatarsal pad that is placed proximal to the metatarsal heads of the space affected, the symptoms can be reduced. The presence of a neuroma requires one or more perineural infiltrations with a combination of a long-acting corticosteroid and a topical anesthetic. The injection is carried out at 45 ° to the foot in the interdigital space posteriorly at the level of the metatarsophalangeal joint. Orthoses with Neurompolster, rest, cold compresses and matching shoes often relieve the symptoms. Ablation techniques such as injection of 20% alcohol with a local anesthetic directly into the nerve under ultrasound or shock freezing of the nerve can relieve the discomfort. If other measures are not sufficient, surgical excision usually brings a complete decay. Not infrequently, however, a new neuroma (amputation or Stumpfneurom) that requires additional surgery developed at the site of excision. Key points of the metatarsals pain can be caused by irritation or benign thickening of the interdigital nerve. Initially slight pain caused by wearing tight shoes can strengthen and adopt a lancinating character, sometimes with paresthesias and / or a foreign body sensation. The diagnosis of the disease is made on the basis of clinical findings, including tenderness and reproduction of symptoms with palpation of the interdigital space. The treatment consists in the variation of the footwear, in the administration of local anesthetics and occasionally corticosteroid, in ablation or surgery.

Health Life Media Team

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